There are many reasons for low awareness of the seizures induced by video games, but today I want to focus on a big one: the lack of current research.

Without new research or a concerted outreach effort by advocacy organizations, it’s tough to keep the issue alive in the media. New research means new findings to announce. The press isn’t likely to cover a subject that’s producing no news.

It’s not as if conclusive studies don’t exist on seizures triggered by video games. Many clinical studies on video games as a cause of photosensitive seizures have been published, beginning in the early 1980s. The findings and methods have been refined over time, but the results have been fairly consistent and haven’t stirred up controversy. In fact, photosensitive epilepsy has always been considered a niche disorder and an out-of-the-way area of research. What’s left to prove?

Today’s studies involving video games are all about how games influence behavior and attitudes. Social scientists are investigating questions such as how much video games affect cognitive performance, memory, physical response time, behavior, and attitudes about violence. The results of ongoing studies like this—unlike the old news about seizures triggered by video games–frequently appear in the news media, keep the issues alive, and are topics of public debate.

The last time significant research findings were published and the advocacy community acted upon this public health problem was in 2005, when consensus papers on photosensitive seizures were published and the Epilepsy Foundation acted by issuing new guidelines for families on preventing them. Very little has occurred or has been published since then to keep the issue before the American public. (One exception: in 2008 the Epilepsy Foundation publicly responded to an Internet attack that placed seizure-inducing images on its website.)

Here’s an example of how things work in the news business.

Last month a pretty balanced piece titled “Video games can be good for you, studies say” appeared in the Chicago Tribune. The reporter, John Keilman, begins the piece by putting video game research into historical context.

Researchers have done thousands of studies on gaming since the 1980s, often with unmistakably negative results. Some associated video games with an increased risk of epileptic seizures, while others cautioned that the games could provoke dangerously elevated heart rates. Many studies also linked violent games to aggression and anti-social behavior.

Then the article turns to Christopher Ferguson, a psychology professor at Florida’s Stetson University who’s found positive contributions of video games:

Ferguson has done dozens of studies on the subject and has consistently found that violent video games do not contribute to societal aggression. One recent project actually concluded that some children who play violent games are less likely than others to act like bullies. [That’s pretty newsworthy!–JS] Ferguson said early research into any new technology is often flawed. Studies that aim to find negative effects get funded and promoted, while those with more benign findings are unpublished and forgotten, he said. When a new generation of scholars more familiar with the technology comes along, different results often appear — and that’s what is happening with gaming, he said. “We’re just not seeing the kind of data emerge that would support the techno-panic that was common in earlier years,” he said.

Although Keilman balanced Ferguson’s remarks with quotes from another researcher, who’s quite skeptical about recent positive findings, there is no further mention in the article of studies about the seizure problem. Readers can easily assume that—as with early studies linking violent games to violent behavior—all the research showing video games can trigger seizures stems from the “negative attitude by technophobes” in the early days of gaming. If one follows Prof. Ferguson’s line of thinking, one could expect that newer studies—if there are any–on seizures and games can be expected to reverse the earlier studies.

I contacted Keilman to point out that the seizure problem hasn’t gone away. He responded that he was aware of this and was interested in writing about it sometime. He also mentioned continuing research on the seizure issue. I think he’d be interested in writing about the subject if there was some new study that’s newsworthy, but there simply isn’t.

In the absence of new research, or a Pokémon-type episode, it’s hard for journalists to write about a topic that just isn’t news.

The Embrace watch doesn’t look like a medical device, but its sensor technology has been used in research published in leading neurology journals. Photo credit: Empatica

Later this year parents will be able to monitor a child’s seizure activity by using wearable technology in the form of a sleek, stylish watch with sensors underneath. The $199 Embrace watch, which will debut in October, could eventually offer a way for parents to learn whether the video games their child is playing are triggering seizures.

The Embrace won’t be able to do a thorough job of that yet—primarily because the device is currently most accurate for detecting tonic-clonic (grand mal, convulsive) seizures. Many seizures aren’t that type; they’re complex or absence, so the device would need to reliably pick up all seizure types. In addition, the Embrace hasn’t been tested specifically for picking up seizures triggered by visual stimuli. In its initial release, though, Embrace will be able to alert parents to tonic-clonic seizures while their child is asleep or in another room.

Most seizure detection devices (except EEG) rely on motion sensors that transmit an alert to a caregiver about a convulsive seizure. The Embrace wristband works primarily by detecting subtle changes in the flow of electrical charges on the skin. These changes in skin conductance are reliable indicators of changes in deep-seated areas of the brain associated with seizures, the hippocampus and amygdala. In times of cognitive, physical, or emotional arousal—and during seizures, these parts of the brain are activated. In some instances, changes on the skin can even be detected prior to the onset of a seizure.

As I’ve noted elsewhere, although EEG is the gold standard used by doctors to diagnose seizures, it’s limited in what it can pick up from structures deep inside brain. EEG uses scalp electrodes to detect electrical signals that first must penetrate the outer brain layers (cortex) and the skull. Because electrodes are affixed to the other side of these layers of tissue and bone, not all seizure signals can be detected at the surface.

The Embrace sensor technology was initially developed by the MIT Media Lab to help people on the autism spectrum to identify and communicate their stress level. The MIT team subsequently discovered that the sensors could detect not only stress/arousal levels but also seizures, including some seizures not picked up on an EEG. A start-up was formed, Empatica, to bring the wearables to market with the help of Indiegogo crowdfunding. I’m intrigued by the company’s roots in technology to aid people with autism; the autism community is probably at highest risk for photosensitive epilepsy and would therefore significantly benefit by being able to identify visually triggered seizure activity.

If your child is fatigued and kind of “out of it” at the end of a gaming session, imagine being able to find out whether hidden seizures are occurring during certain games. Wouldn’t it be great to be able to correlate seizure activity with specific video games? I’d love to see this application of the Embrace watch come about.

William and Kate arriving in New York, as seen on the CBS Evening News.

When the Duke and Duchess of Cambridge arrived at their New York hotel this week, it was big news. Did you catch the squeals of delight from the crowd and the flicker of so many cameras flashing? The arrival scene was featured on a number of American news programs.

How it was seen in the UK

This same New York arrival scene was shown in the UK as well—but with an important difference.

This same scene was shown on the UK’s Sky News. Notice anything different?

Rapid-fire flash photography from the swarm of media creates a strobe-like effect on the image, which is known to trigger seizures in some people. In the US this material is broadcast despite the seizure risk.

But for more than 20 years, TV programs and commercials flashing at frequencies that can provoke seizures have been barred from broadcast in the UK. An exception to the regulation is made for breaking news coverage, where potentially seizure-inducing material is allowed to air if accompanied by a warning. These regulations were put in place after a noodle commercial triggered seizures in several British viewers.

Out of curiosity I tested a video clip of that New York sidewalk scene to see if the flash freqency falls into the category of a seizure hazard. I used an application called the Harding Flash and Pattern Analyzer (below) that assesses video sequences for seizure safety. The clip did in fact exceed flash safety limits for people vulnerable to visually induced seizures. Folks in the UK at least got an on-screen warning, which perhaps gives susceptible viewers a chance to avert their eyes.

News video of the royals arriving in New York did indeed fail the seizure safety test, as indicated by the green line above the pass/fail boundary on the graph. Screen is taken from the Harding Flash and Pattern Analyzer.

What happens when American TV programs are shown in the UK?

TV programs and music videos imported to Great Britain from the US (and other countries) need to be tested first, then modified to comply with the British seizure safety mandate. An engineer in a London post-production studio who does this compliance work shared with me that a popular US crime series had nearly 150 violations of seizure safety guidelines in a single episode. Where is the consumer lobby for seizure-safe TV programming in this country? Anybody?

First-person shooter game Halo: The Master Chief Collection was one of the recommended Xbox titles that poses a seizure risk.

Half of the Xbox-exclusive games selected by GamesBeat for its 2014 holiday gaming guide appear to be free of seizure-provoking visuals. But since there were just 4 Xbox games in the buying guide, we’re talking about exactly 2 safe games. I don’t know how representative this sample is of the universe of Xbox-exclusive titles.

About these games and test results

Disney Fantasia: Music Evolved isn’t a game in the conventional sense; it’s a rhythm game played by the motion of the player’s arms, enabled by the motion-sensing Kinect controller. There are no battle scenes that might set off visually risky explosions, or races with crashes and fast-moving scenery. Instead, when players “conduct” to the beat of music selections, all sorts of colored patterns are created and set in motion on the screen. It’s visually interesting yet not overstimulating. There’s a lot of safe black space separating the smaller colorful elements.

Sunset Overdrive, released by Microsoft Studios, is a third-person shooter game, a relatively safe genre seizure-wise. Because these games tell a story from the perspective of an observer of the action, scenes are shown from a wide angle. This means that, unlike first-person shooters, any bright, explosive flashes and rapidly swirling debris don’t dominate the field of view. The larger the screen area of patterns flashing images, the higher the likelihood is that those visual effects might provoke a seizure.

The Halo image at the start of this post is shown here in the upper left of a screen from the seizure safety testing application. The image occurs in a stretch of gunfire with flash levels exceeding seizure safety guidelines, as shown by the red line on the graph.

So it’s not surprising that first-person shooter Halo: The Master Chief Collection contains seizure-provoking images. Its predecessor Halo 4, which I tested 2 years ago along with other FPS games, failed the flash and pattern analyzer safety test, too.

Not so surprising, either, that the racing game Forza Horizon 2 violated seizure safety guidelines. As I’ve previously found, the quick cuts, fast-moving scenery, and dramatic collisions featured in the racing genre result in games that exceed or approach seizure safety guidelines. The original version of the game, which I tested nearly a year ago, contained a lot of scenes that flirted with safety limits, but I didn’t locate actual safety violations.

Summing up GamesBeat’s 2014 holiday gift guide

This completes my safety assessment of games chosen for GamesBeat’s 2014 holiday gift guide. In recent posts I’ve reported on the seizure safety of the guide’s recommended multiplatform games and games exclusive to Nintendo, Sony, and PCs. After testing all 43 games in the GamesBeat 2014 holiday guide, it appears that 26 titles–60 percent–contain image sequences capable of provoking seizures.

Just 40 percent of games recommended in the GamesBeat holiday guide passed the seizure safety test.

These are supposed to be the best games–how seizure-safe are the worst games? Or the not-especially-noteworthy? If I had unlimited time and testing resources, we could find out. Consumers deserve to see reviewers rate games for seizure safety, not just for graphics quality, speed/performance, modes of play, characters’ personalities, levels of difficulty, modes of play, frame rate, music, and so on.

Disclaimers

Your results could vary. Games I’ve listed as safe could have seizure-provoking sequences that I was unable to locate. I don’t do this testing while actually playing these video games. Instead I work with video clips available online, some of which are official marketing and gameplay trailers and cutscenes; others are gameplay sessions posted by reviewers or fans. I do not test fans’ gameplay from games that were acknowledged modified with other software.

In addition, the seizure threshold of individuals is affected by a number of factors including illness, hunger, stress, fatigue, length of play, and menstrual cycle, among others. So a game that seems OK may subsequently trigger a seizure under different conditions.

Testing methodology

I run downloaded gameplay clips, cinematic clips, and promotional trailers for each game and submit the sequences to the Harding Flash and Pattern Analyzer. The FPA is widely used by producers and networks in the UK—including by the BBC—to ensure seizure safety of all material on broadcast TV. It examines video sequences for very specific and measurable image qualities that researchers have found can trigger seizures:

rapidly alternating light and dark images (flash/flicker)

certain stripes and geometric patterns with high contrast

large areas of very bright (“saturated”) red

problem images take up more than one fourth of the screen

If the first clip I test of a game fails the safety test, I note that and move on to test the next game. I typically test at least 4 or 5 additional clips of a game if no safety violations are found initially. If I have a high level of suspicion due to the game genre and/or overall look of the sequences that there might be unsafe “footage” that I haven’t yet found, I may test a lot more clips.

A case history in a 1994 medical journal documented seizures in a 13-year-old boy that were triggered by a Sonic the Hedgehog video game. The Sonic games just tested continue to include seizure-inducing sequences.

Been thinking about buying any of the 11 titles that GamesBeat thinks are the season’s best Nintendo-only games? Testing shows that just four seem to be free of seizure-provoking visuals.

Among the Nintendo games that don’t comply with seizure safety guidelines are several that one would expect to be seizure-inducing. Two brand-new animé-style games, Persona Q and Hyrule Warriors, predictably failed the seizure safety test because animé typically does. Unsafe graphics in Sonic the Hedgehog and Super Smash Bros., two of the most well-established game franchises, are consistent with seizure-provoking games in their respective product families.

GamesBeat picked these Nintendo-only titles for its early holiday gaming guide this year.

Pokémon video games vs Pokémon video game trailers

Of the three Pokémon games, one isn’t really a game so much as a set of digital drawing and painting tutorials. Interesting that the other two Pokémon games are safe, too. I instantly associate Pokémon with the so-called Pokémon incident in 1997. That event was a Pokémon cartoon broadcast, when about 600 Japanese children simultaneously experienced seizure symptoms severe enough that they were taken to emergency rooms.

Maybe because of that history, I thought, the developers of these games have taken extra care with image safety? To test this theory I put a few other Pokémon games through an image safety assessment tool—the others passed, too.

Hold on, though. Although the Pokémon games themselves still use the same not-very-animated, not-very-2014, unlikely-to-provoke-seizures style of animation of much older games, a promotional video for these same games violates seizure safety guidelines big time. How can that be? Here’s how: a just-released trailer for Pokémon Alpha Sapphire and Omega Ruby is done in a more traditional animé style. So technically the Pokémon games pass the seizure safety test–but beware of seizures from the videos that market the games.

The new animé-style trailer for Pokémon Alpha Sapphire and Omega Ruby uses much bolder graphics …

…than the Pokémon games it’s promoting. While the game is safe, the eye-catching trailer fails the seizure safety test.

“To celebrate the upcoming release, the Pokemon Company has launched an anime style trailer for the two games…It’s pretty cool of Pokemon to release an anime styled trailer, given how popular the series and manga is. And even though the anime and game are very different from each other, fans of the series are still going to appreciate the extra effort.”

When The Pokémon Company in 2012 used this same marketing strategy with an animé promotional trailer to “celebrate” the release of non-animé Pokémon Black 2 and Pokémon White 2, Youtube viewers of the combined trailer lamented that the (seizure-inducing) animé in the promotional clip looked a lot better than the humdrum (visually safe) appearance of the games’ graphics.

These visually jazzed-up trailers would seem to raise customers’ expectations that in future releases The Pokémon Company intends to incorporate animé style into cutscenes and perhaps gameplay.

Testing Methodology

To test the games I submit downloaded gameplay clips and promotional trailers to the Harding Flash and Pattern Analyzer. The FPA is widely used by producers and networks in the UK—including by the BBC—to ensure seizure safety of all material on broadcast TV. It examines video sequences for very specific and measurable image qualities that researchers have found can trigger seizures:

rapidly alternating light and dark images (flash/flicker)

certain stripes and geometric patterns with high contrast

large areas of very bright (“saturated”) red

problem images take up more than one fourth of the screen

Sequences submitted for analysis are video clips available online, some of which are official marketing and gameplay trailers; others are gameplay sessions or cutscenes posted by reviewers or fans. I do not test clips uploaded by fans who have modified the game software.

Action game Bayonetta 2 consists of long fight scenes filled with motion and bright colors.

I typically test at least 4 or 5 clips of a game if no safety violations are found in the first clip. If I have a high level of suspicion due to the game genre and/or overall “look” that there might be unsafe images that I haven’t yet found, I may test a lot more clips. Before finding a clip of Bayonetta 2 that failed the test, I tested about a dozen clips. Its large, fast-moving, brightly colored designs led me to believe there had to be seizure-inducing sequences.

Disclaimer

Your results could vary. Games I’ve listed as safe could have seizure-provoking sequences that I was unable to locate. Furthermore, the seizure threshold of individuals is affected by a number of factors including illness, hunger, stress, fatigue, alcohol, and the player’s menstrual cycle, among others. So a game that has caused no problems over an extended period of use could still trigger a seizure under different conditions.

Better news than usual. For people susceptible to photosensitive seizures, the five best exclusive-to-PC games for the holiday shopping season (per GamesBeat) appear safe. Well, mostly.

There’s one very important caveat: While the gameplay itself seems to stay within visual safety guidelines, a cinematic clip from World of Warcraft: Warlords of Draenor failed image safety tests. You can apparently play World of Warcraft safely, but you need to beware of the risk of seizures from the cinematic game openers and other in-game cutscenes and cinematic material that move the story along. I didn’t give the game a passing rating because it’s likely that players will see the problem video sequences.

Going forward, when testing games for seizure safety, I will routinely test cutscenes in addition to gameplay clips. Unfortunately it’s quite possible that in preparing prior posts I’ve been unaware of some safety failures because I wasn’t systematically looking to test these sequences. I plan to revisit the test results I’ve recently posted and will be updating those posts with any new findings.

Four of the five games are either role-playing (RPG) or strategy games, which tend to be shown from a wide angle that permits scenes showing entire battle fields. These “big picture” scenes are less likely than close-up shots to have areas of flash, saturated color, and patterns that take up a major portion of the screen. Unless these visual effects cover more than one quarter of the screen they do not typically pose a seizure risk.

The flash problem

In the problem sequence in Warlords of Draenor excerpted below, a bright orange screen alternates with a darker screen. The switch between dark and bright happens several times within a fraction of a second. The rapid sequence creates a flash, and because it occurs faster than 3 times per second, it exceeds the flash rate safety limit for photosensitive epilepsy.

The bright orange frames alternating with a black and white image in this sequence from World of Warcraft: Warlords of Draenor creates a flash effect. This sequence of screens, captured by the Harding Flash and Pattern Analyzer, represents roughly a third of a second of video.

For people with photosensitive epilepsy, flashing red (or shades of red) creates an even higher seizure risk. When the video sequence (at bottom of the analysis tool screen capture below) is assessed for seizure safety, an unsafe level of flash is shown in the green line on the graph. The level of red flash (red line on the graph) is even further beyond the safety limit.

Disclaimers

Your results could vary. Games I’ve listed as safe could have seizure-provoking sequences that I was unable to locate. I don’t do this testing while actually playing these video games. Instead I work with video clips available online, some of which are official marketing and gameplay trailers; others are gameplay sessions posted by reviewers or fans. I do not test fans’ gameplay from games that were acknowledged modified with other software.

In addition, the seizure threshold of individuals is affected by a number of factors including illness, hunger, stress, fatigue, length of play, and the player’s menstrual cycle, among others. So a game that seems OK may trigger a seizure under different conditions.

Testing methodology

I run downloaded gameplay clips, cinematic clips, and promotional trailers for each game and submitted the sequences to the Harding Flash and Pattern Analyzer. The FPA is widely used by producers and networks in the UK—including by the BBC—to ensure seizure safety of all material on broadcast TV. It examines video sequences for very specific and measurable image qualities that researchers have found can trigger seizures:

rapidly alternating light and dark images (flash/flicker)

certain stripes and geometric patterns with high contrast

large areas of very bright (“saturated”) red

problem images take up more than one fourth of the screen

If the first clip I test of a game fails the safety test, I note that and move on to test the next game. I typically test at least 4 or 5 additional clips of a game if no safety violations are found initially. If I have a high level of suspicion due to the game genre and/or overall look of the sequences that there might be unsafe “footage” that I haven’t yet found, I may test a lot more clips.

In recent posts I’ve shown the results of testing editors’ picks for best-of-Sony and best-of-multiplatform games for this year/holiday season. Both groups included lots of seizure-inducing titles. In coming posts I’ll look at best of Nintendo and Microsoft games.

Here’s another batch of exclusive-to-Sony game titles that I tested for seizure safety. These eight games were chosen by Inside Gaming Daily as the year’s best Playstation-only games. Of the eight, five contain images that could provoke seizures in viewers or players.

The test results:

Inside Gaming Daily chose these as the year’s best Playstation 4 2014 titles.

An example of totally unnecessary seizure-provoking material

Scenes of the playing field and the stands in MLB 14: The Show don’t contain seizure-provoking sequences. But the alternating blue and red stars that occasionally scroll across the screen, between plays, for a fraction of a second are a problem. They create enough flash effect and saturated red to provoke seizures. The game could be seizure-safe game just by omitting these graphics sequences.

Nothing in the visual presentation of the game play itself would provoke a seizure.

But these fast-moving graphics sequences that appear between plays are not in compliance with safety guidelines for preventing visually-induced seizures.

Even though the blue and red graphic design appears for less than a second…

…the alternating colors create a flash effect and include a large screen area of saturated red. This sequence, which appears periodically throughout the game, fails the seizure safety test on both counts.

Testing Methodology

To test the games I submit downloaded gameplay clips and promotional trailers to the Harding Flash and Pattern Analyzer. The FPA is widely used by producers and networks in the UK—including by the BBC—to ensure seizure safety of all material on broadcast TV. It examines video sequences for very specific and measurable image qualities that researchers have found can trigger seizures:

rapidly alternating light and dark images (flash/flicker)

certain stripes and geometric patterns with high contrast

large areas of very bright (“saturated”) red

problem images take up more than one fourth of the screen

Sequences submitted for analysis are video clips available online, some of which are official marketing and gameplay trailers; others are gameplay sessions posted by reviewers or fans. I do not test fans’ sequences from games that were modified with other software.

I typically test at least 4 or 5 clips of a game if no safety violations are found in the first clip. If I have a high level of suspicion due to the game genre and/or overall look of the sequences that there might be unsafe “footage” that I haven’t yet found, I may test a lot more clips. Then there are games like Entwined–as soon as I started viewing the first clip, I strongly suspected there would be seizure-provoking sequences.

Entwined is beautifully depicted on the screen…

…but unfortunately it has many fast-moving patterns and a lot of bright flashing, too.

Disclaimer

Your results could vary. Games I’ve listed as safe could have seizure-provoking sequences that I was unable to locate. Furthermore, the seizure threshold of individuals is affected by a number of factors including illness, hunger, stress, fatigue, and the player’s menstrual cycle, among others. So a game that seems OK the first time it’s played may trigger a seizure under different conditions.